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Home My WebLink AboutPermit Electrical 2006-7-28 .' ~ i' C CITY OF SP0\JGFIELD, OREGON n 225 FIFfH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPUCATION r 1'1f'v-, ';)0-0 (, ~ DtY14fo I '.. ~ City Job Number I. I LOCATION OF INSTALLATION .551;~ t'Y\Cc.\b,,~ iPr....... S'~:~Oc;:,a:l. LEGAL DESCRIPTION 1::J (l'" ~d- L"l, IS~OV JOB DESCRIPTION 'Ke?c Ac I ~<r- -S 1::=i2. V (Q. C' ~ Permits are non-transferable and expire if work is not started witbin 180 days of issuance or if work is Suspended for 180 days. 2. I CONTRACTORINSTALLATIONONLY I / City Supervisor License N Expiration Date .Signature of Supervising Electrician Owners Name lAJa 1. ol- ~ "'~CL~"~ W ~ Address _S"is!':: "'^"'\\~.:\. Vin."" City S\>v~\.U>~A 'v Phone 510-'\,1" I OWNER INST ALLATlON The installation is being made on p.vp....; I own wbich is not intended for sale, lease or rent. Owners Signature: ~~~~ '\.)0..' '\."_~ Inspection Request: 726-3769 Date ,/J.--dOfo ~~~ .~ 3. I COMPLETE FEE SCHEDULE BELOW (')e.. A. I New Residential- Single or Multi-Family per dwelling unit. Service Inclnded 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manumct'd Home or Modular Dwelling Service or Feeder $106.00 $ 19.00 $50.00 B.I Services or Feeders - Installation, Alterations or Relocation: J .200 Amps orless $ 63.00 -Ln9.,. oi) 201 Amp's to.400 Amps $ 75.00 40i''Afu'JsG~600Amp's LL EXPIPe If: THE '$125\00 Lj\s PERMII ::" 11\ ~ "'"I" 601 'Anips(t'?J 1000JAmpsER WIS PERMIT I $163!00 11 \.1 j~ILtl . Ul\;U Fr.~ Over ,1,o09,,~ri,1P.S[6oL~\ IS fl.8ANOONED '$375.00 Recormect Only ;)>>\\[)IJ $ 50.00 C. I Temporary Services or Feeders '1 Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps Over 600 Amps or 1000 Volts see "B" above. D I "B'" 'h~'C"'"I"t" urenon 'ClW '''\.jUII''~ you.to . ~ranc . IreUl S:.;1 . . . . . fo;,v" ,uk.... aJu,,;cu ~y lhe-Breg0fl-tltilit'j N~u~'!~!:.'!'!'1!'I.'!!;;~.!\en~i'1!!~ertf!!!!"lre set forth Ol]e, ~ircl\it;52.001.001 0 throuoh OAR 95$ 43WO Ea'iM.!!di!i9!)l\I,~ircEiJl!!Jr~!t!!pies of the rules bV Service orEeeder Permit. (N t . ". - <-'--h$r3,OO vdlllllg lllC ~~Illvl. 0 8. ~,..... ...........t-"~ U n:: I IIU/JlUCI ;Ul l;IC 0IC\.IUlI L~{:;~~tfteatieR I E. Miscellan~.'!~I~f:tifilfts.~S1l:!'_'l!j.!/!}~~ded) -Eacb Installation $ 50.00 $ 69.00 $100.00 fump or irrigation , Sign/Outline Lighting Limited Energy/Residentiat Limited Energy/Commercial $ 50.00 $ 50.00 $ 25.00 $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4.1 SUBTOTAL OF ABOVE ~?J.oD 5',04 if), ~7\ 1 74.~Lf 8% State Surcbarge 10"10 Administrative Fee TOTAL ....._u.. ro._,___,......~"'__"..,__ ...__.___...... .L_'__' "'___." . _..",u".,_ . ^; ..__ .,' . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-00946 ISSUED: 07/27/2006 APPLIED: 07/27/2006 EXPIRES: 0l/2712007 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 585 MALLARD AVE ASSESSOR'S PARCEL NO,: 1703221315600 Springfield TYPE OF WORK: Electrical Work Only PROJECT DESCRIPTION: Replace service, \.! OTrt>:'p:E OF USE: Repair Residential rllS PeRMIT SHALL EXPIRE IF THE WORK II,l!{'!117rn 1II\lnrn Tllll" n,nllAlT l{" ..tnT Owner: VANDER MEER WADE R & B J Address: 585 MALLARD AVE SPRINGFIELD OR 97477 diVii,1E:Nl:to OR IS lI'3ANDONED FOR " ',V "Cl1lni:. Contractor Type Electrical Contractor OWNER I l.Vl' I "ACTOR INFORMATION I License Expiration Date Phone BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Lot Size: Height of Structure Sq Ft 1st Floor: Type of Heat: A T-=.' . S~ Ft 2~d Floor: Water Type: ,. :-' -.. TION. CSq!Ft1Ba.semen~:'ires you to Range Type: . ' , ',Y': :UIC~ a:::CSq'Fi G.arage/.l!:a."P9r,tUtility Energy Path: ., .' ;,~ ~,l ventSq FtOther:lles are set forth Sprinkled Building: 'n,; ',,, 'n'fli"001-(0ccupantl~0~dJAR 952.001- nr__"'l v"., ........_.. _._. . . I DEVELOPMENT INFORMA:f<ION111e ~ent~~iN;;;;~;h~'t~;:~~~erJ~aoy IIUlllu(:r 101 the Oregon REQUIRED PAt RKING . I...nll"y I\lUlIltCa Ion Overlay Dist: Center IS l'800'~TOtal:344). # Street Trees Rqd: Handicapped: Paved Drive Rqd: Compact: % of Lot Coverage: Front yard Setback: Side I Setback: ~ Side 2 Setback: Rearyard Sethack: Solar Setbacks: , PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: Downspouts/Drains: Notes: I Valuation Descriotion I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Paee 1 of2 'L., . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-00946 ISSUED: 07/27/2006 APPLIED: 07/27/2006 EXPIRES: 01/27/2007 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Pbone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project ~ Fee Description + 100/0 Administrative Fee + 8% State Surcharge Perm ServIFdr 200 amps or less Amount Paid Date Paid $6.30 $5,04 $63,00 7/27/06 7127/06 7/27/06 Receipt Number 1200600000000001151 1200600000000001151 1200600000000001151 Total Amount Paid $74.34 I Plan Reviews I To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. IRenll~ Electric Service: Approval required prior to utility company energizing service, By signature, I state and agree, tbat I bave carefully examined tbe completed application and do hereby certify that all information hereon is true and correct, and I further certify tbat any and all work performed sball be done in accordance with the Ordinances of the City of Springfield and tbe Laws of the State of Oregon pertaining to tbe work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety, I further certify that only contractors and employees who are in compliance witb ORS701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during construction. Owner or Contractors Signature Date Paee 2 of2 ,... . 225 ~irth Street Spfingfield, Oregon 97477 541-726-3759 Phone .~~ IA: car Springfield Official Receipt D~lopment Services Department Public Works Department RECEIPT #: 1200600000000001151 Date: 07/27/2006 1l:21:56AM Job/Journal Number COM2006-00946 COM2006-00946 COM2006.00946 Description Perm ServlFdr 200 amps or less + 8% State Surcharge + 10% Administrative Fee Payments: Type of Payment Cash Paid By WADE V ANDERMEEER Item Total: Check Number Authorization Received By Batch Number Number How Received ddk In Person Payment Total: Amount Due 63.00 5.04 6.30 $74,34 Amount Paid $74.34 $74.34 cRecc:intl Page I of I 7/27/2006 , . . July 28, 2006 Wade Vandermeer 585 Mallard Avenue Springfield, Oregon 97477 Enclosed is a form from the State of Oregon Construction Contractors Board that we neglected to have you complete and sign when you obtained your permits on July 27th, 2006 for the electrical alteration to your residence at 585 Mallard Avenue, Springfield, Oregon. Please fill in the appropriate "boxes" and sign and date the form. Please keep the pink copy for your records and return the white original fonn to me in the enclosed self stamped envelope at your earliest convenience. Thank you, and if you have any questions, please feel free to phone me at 726-3753. Sincerely, Nancy Machado Community Service Division Enc!. ,.- 01/17/2006 10:59 , CITY OF SPRINGFIELD PAGE 01 9PAINGtrll!\.D .~-~,~,.,,:"~,,,~. 225 FJFTH STREET. SPRINGFIELD, OR 97477. PH:(54I)726-3753 . FAX; (541)726-3689 ELECTRICAL PWf'l.!T APfpCATION City Job Number --\;.!V,lA.ac\ 0 . 1.1"lt6.,.''".,,',''ij,m.'iNl.i~..'.,~,'~,''',., !Ji...rl:)t.~~1.jJlffimr:;~ 3. IfiOO.~~jRmJ!t~~ilt~ii"\i~I'J'~..iIiiJ;i1i...' ."., .. ..." '<:)' .'...,...... .... ....... ,....... "..,.. r!:!,iiii,.,.. i"i~r:r..c, I".,....'r~~~,~..,~~,~".,'".."..,.... """"',,!,',.,._AI;i1<Ill~N_,.,.,.,, fl:lh M~HAI\ ="""1--'''-' ' ~ \ 'JNeli\'I~df~~ij";~S~"" il!ili' lmii~'pfl~lflt\',i','''~ LE~*R~~'Wl?~ \c:.....I'/'f 1 A. ~,.. ...,il.,."., .,'", "~'')(TTEe~r N:~'reg6n~w"requii'!s,~g~ IU \ I IlJ~1 . \ . ":' <> JA)J Service InclDded follow rulb:8 adopted by the Oregon Utility J~ DESCRll'TJON C \ * (\ fI./. \' f) ~~~ :;~;;t~6'Aoti,fi.C'Mlon Center. ThuSJ~8Ile: :m sa: fortr ,,~~ T AQl' <. 'tXlJ\C't.{"'~OI\thereOf !n5AH952'OO1.0010tt>$l~WOAR952.001 . 0090, You m..y Vt....." caples VI ."" IV...S b' Permit, a e non.transferahle and elpire If work Is Each Manufact:d H~aWinll the center. (Note: the telephone . not started within 180 days or Issuance or If work is Modular Owelhng Service of' . . . SDspeDded for 180 days. Feeder numDer for Ihl! OrAnp;li5,Q.ll!lty NoltflclltJOn i~ll~lJlfa;fifi1l~~itl""Jt ' "Wi~'f B.I;I~WiM:~~*~.t~!4ihl&M~~~~:~i~~~~~~;l~i'J:+fj 2~ "'~J.i ~'i" ~~~':~~.~ ;,,~.!;:, ~'I':;:'~',,l;lt'i. .;1' ~ I :' .'j~)I',r-ri:~'U 1~I~l,I.~;~n;\~I~" J~'~ p,~~ ,'1'.rJW~, ....r:~:., J~:~f'!".~l!;;j "'~:!!(~,~t~"'~:\!I!~'i'~"":~'::'~I:n~t.. ~:;lH~~!~~.~~~,l!!~....!::~.~~lr.:!!i~.;~ j,i!~I;;~':1~.;fi,::'P~': Datc Constr, Contr, Number ElcetricalCOI\traetorNew Way Electric. Inc. 200 Amps or less \ $63.00 ID~.ob 201 Amps to 400 Amps $ 75,00 401 Amps to 600 Amps $t25,OO 601 Amps to 1000 Amps $t63,OO Phone 686-2365 Over 1000 AmpsIVoits $375,00 /IJ U neE: Reconnect Only $ 50,00 32828 THIS PERMIT;:;l'<:"^,,,~,";i.,~, "'"C"~'~'~'''''''b'C'''''''"''''' ''', '''''''"''''''j''''''''''~ S'l'I'\PP'UisorLicense Number \:;'rt:.!;!Wj.t .~~. itA I,' 'e'nJ:~1" f'.~ ~ ~"'I"~~I",.~~I'II~r,J;:'~-'l:liII'~""" ~ ---" ,t:-:-::CiiIZED UNDER'~\"I~h.,!: 'lfI ORK.'" .' ,:'1'.':<: ''''&''''.''''''",' COM MEN C ED 0 ~nstal\ati~~~ 1',ttlU,V,[ o'.sR~J9iiOlion ANY 180 DAY PEi9n~{I.~M\1,QNED FOR 51088 20'tJAlnj,s to 400 Amps 401 Amps to 600 Amps Over 600 Amps or 1000 Vol'" see "B" above. D l;JitD.:J::..\:!.litlf~~.:.i'.ilf;M:':J~ii ii:;I: i:.i::~~:~H~,.""I'!;"I'li~;;':~":'I{':". ';:ni!li~;~!(.'!j."'~ilf!i.~;' .'H'j:I,~n;;;::r . t.-;L...~. ",,1~~~~~~lif,~~<:~~hfi!:f~i~iEii; :1;"\~~i.:~!~:f~j:~:,;~~:;f,~:~:%:>Ji:U;~~~~:~i~~:{~L1~ Address P.O. Box 21503 City Euqene Expiration Date 10-01-07 City $ 50.00 $ 69,00 $ t 00,00 Owners Name New Alteration or Extension Per Panel One Circuit $ 43,00 , " . f Each Additional Circuit or with - OJUi Service or Feeder Permit $ 3,00 1\ l ~ E. 'f;iMl'Mi1~i~~~Eii1~~a~i,i~b~:ilIr3J'g-:B:.limmlitilljji!; u 1r.:~:".~'~~I;:.: ~I . "i Ii '.U'''~I..'';';"' rill,..I,~.i "I,r' .'.1 ".::' "',:' . ..,,', ~'~."'. i'l 1~?i.I'...." ~~""~"~.'I_. 'i~ '''' I.... j...:,: enD. 1w( pumporirrigatiOn' ..... '$50,~""''''< Sign/Outline Lighting $ 50,00 Limitod EnergylResidential $ 25.00 Limited Energy/Commercial $ 45.00 ~ ,y OWNER INST ALLA TI N The installation is being made on t"vt"...../ I own which is not intended fOT sale, lease or rent. Minimum Electric Permit Inspection Fee Is $45.00 + Surcharges ~"~t;''''I'~'''''a:lj'i!1!~''''''''''''''J'''J'''''.'''''~''. \ 1J r/J "::~t:l'lIt~~'1i'!!'~\1f t ~.~, TOTAL ,4 ~ Owners Signature: '_00"'_ n":%\9~ '? ~~~~~(~~ ,. DATE, TIME FAX NO./NAME DURATION PAGE(S) RESULT MODE ~ TRANSMISSION VERIFICATION REPORT 08/01 01: 16 96862715 00:00:38 01 OK STANDARD ECM . TIME 08/01/2006 01:17 NAME CITY OF SPRINGFIELD FAX 7263676 TEL 7263676 -. . . . . . . ", " " " . .. ~ Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us pennit#~ - 009YY \, Address: 68'5 Int2LtPlAcJ..;, ~(LA-_ Issued bY~ i' /:to J<. Date: t,t:r(/?~ Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submit this statement. This statement will befiled with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: ~ 1. D 2. I own, reside in, or will reside in the completed structure. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. D 3A. My general contractor is (Name) (CCB #) I will instruct my general contractor that all subcontractors who work on the structure musl be licensed with the Construction Contractors Board. OR [2g 3B. I will be my own general contractor, IfI hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notifY the office issuing this building permit of the name of the contractor. f I hereby certify that the above Information is correct and that I have read and do understand the Information Notice to, Property Owners about Construction Responsibilities on the reverse side of this form. cJaA ~~p~':",mt) ~h/~)G (White copy to issuing agency permit file, pink copy to applicant.) Property_owner.doc 06-01-04 NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many proolems by being aWare of the. folloWing responsibilities and concerns. JEmlPnoyer ResponsibiLities . ~. ). . - . You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you use contractors not licensed with the Construction Contractors Board to do labor in' constructing or to assist in the construction or improvement of a residential structure.. As the employer, you m.ust cl!mply ~ith the following: . . . .. Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503-378-4988.' . Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. The Oregon Business Identification Number (BIN) is a combin~d nwnber for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/fonnsnav.htmlI for the ayt'&VYA~ate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Cv......~usation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division at the'Department of Conswner and Business Services at 503-947-7815. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at 1-800-829-4933 or visit their web site at www.irs.l!Ov.' Other JRespolllsibiHides amB Areas of Concems . , . Code Compliance: As the permit holder for this project, you are responsible for resolving any failUre to meet code requirements that I?ay be brought to your attention through inspections. Liability and Property Damage Insurance: Contact your insurance agent to see' if you have adequate insurance coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be redone. Time: Make sure you have sufficient time to supervise your employees. Expertise: Make sure yoti have the skills' to a~t as y~~ own general co~tractor" to coordinate the work of rough-in and finish trades, and to notify building officials as the a"", v",;ate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. , . Property_owner .doc 06.0 1-04